Should we treat with continuous positive airway pressure severe non-sleepy obstructive sleep apnea individuals without underlying cardiovascular disease?

Sleep

article

Pengo, Martino F¹  Gozal, David²  Martinez-Garcia, Miguel Angel⁴ 

[1] Istituto Auxologico Italiano IRCCS;Department of Child Health and Child Health Research Institute, University of Missouri School of Medicine;Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine;Respiratory Department, Hospital Universitario y Politécnico La Fe;Centro de Investigación Biomédica en Red ,(CIBERES), Instituto de Salud Carlos III

关键词: obstructive sleep apnea;    continuous positive airway pressure;    nocturnal hypoxia;    cardiovascular disease;    obesity;    hypersomnia;   

DOI  :  10.1093/sleep/zsac208

学科分类：生理学

来源: American Academy of Sleep Medicine

【 摘 要 】

The majority of the current international obstructive sleep apnea (OSA) guidelines base the recommendation to treat OSA with continuous positive airway pressure (CPAP) on the presence of symptoms (principally, albeit not exclusively on daytime hypersomnolence). In nonsleepy patients, even with severe OSA, controversies remain, as clear evidence supporting CPAP treatment of this subgroup of OSA patients is lacking. However, given the nonnegligible proportion of non-sleepy OSA patients, clinicians often face a serious dilemma since CPAP treatment in these patients may prove to be not cost-effective. Here, we propose a simple three-step-based algorithm that attempts to better phenotype non-sleepy OSA patients prior to reaching a CPAP treatment decision while also considering a series of clinically relevant elements in the process that may improve with CPAP therapy. Such algorithm focuses on the presence of several OSA symptoms that are susceptible to benefit from treatment and also relies on OSA phenotypes that need to be considered in an effort to achieve optimal cardiovascular prevention. Here, we attempt to establish a framework for clinicians who are evaluating severe nonsleepy OSA patients in their practices. However, the algorithm proposal needs to be extensively validated before being systematically implemented in clinical settings.

【 授权许可】

All Rights reserved